Every generation likes to think they're free, and often only the clarity of hindsight reveals just how restricted they actually were. My mother, for example, thought, like many women in the 1970's, that it was the very pinnacle of freedom to have her labour induced, to be able to choose on which day of the week her baby came, and to be in a hospital which offered 'state-of-the-art' care for her and her baby. Looking back on it now, she can see just how far from freedom she truly was: shaved, enema'd and pethidined, with no formal talk of consent, and later, ushered sternly back to bed by Matron as she wandered the hospital corridors, drug-hazy and looking for the baby they had taken from her.
Nearly forty years later, that baby - me - is pregnant for the third time, and wondering - am I free? Do I have full freedom of choice to have the birth I really want and need? Can I feel assured that anything that is 'done to me' in the name of medical science will be absolutely necessary and helpful? And are there restrictions that none of us are even able to see, and that will only become apparent when the baby inside me is fully grown and making their choices against a new and different backdrop?
Already I have met resistance to my plans to birth at home. At my first appointment with the midwife, the flag was automatically raised because my last baby was born weighing ten pounds four. This is me just after I birthed her. You can see just from my face what a life or death struggle it was:
She was born in the water after a second stage that lasted about ten minutes, without a whiff of gas and air, without a single vaginal exam, without any instructions on when or how to push, without a hand laid on me except in love, and without a stitch.
But because she was 'so big', 'they' want me to do things differently this time. They want me to have consultant led care, a hospital birth, and an induction at 38 weeks. (That's a whole month before either of my other babies have been born - I'm a ten month mama!)
The size of my baby might have been a 'flag' for them, but let me tell you, I have 'flags' too, and I know how to wave them. They might not trust my body - but I don't really trust them - there are things that make ME lose faith in THEIR abilities. I don't want to list in detail all of my reasons here - I never want this blog to single people out or publicly criticise individuals - but let's just say that a few incidents and some inside information has led me to feel a lack of confidence in my local maternity unit, and a strong suspicion that they don't trust birth and don't have much faith or understanding of it as a completely natural process.
This local feeling would seem to reflect a national and international picture. In her latest book, 'Birth and Sex', Sheila Kitzinger describes a climate in which 'choice' is a buzz-word that is meaningless when applied to women's actual realities: "The rhetoric of 'choice' ignores the pressure exerted on women to have a particular birth place - hospital - and kind of care - obstetric management, and the power of the medical system, so that discussions about choice often amount to emotional blackmail."
Worse still, it seems that even those midwives who wish to support real choices have their hands tied. Kitzinger writes, "Midwives who support women in their own free choices are more at risk of being reported to the Nursing and Midwifery Council and losing their registration."
The prosecution and persecution of midwives who refuse to, as Kitzinger puts it, "guide women to 'correct' choices", is epitomised currently by the case of Becky Reed, held in the highest regard by leading members of her profession, a member of the legendary Albany midwives, and up before the NMC on the 11th March. Her campaigners state, "For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy. If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices."
They might well have written, 'make it EVEN MORE difficult' for it seems like this is already very much the case. As a trainee midwife recently said to me, "I'm already learning that it's best to keep any strong views or opinions to myself, otherwise I'll risk not getting the job at the end of training.", and a qualified midwife confirmed, "At the end of the day, it's a job and you have to feed your family. If you make too many waves you put yourself at risk."
In this climate of fear and mistrust, how can any of us be truly free?
For me, too many flags and a search for true freedom have led me, as I did in my second pregnancy, to book an Independent Midwife. I just don't want to give birth in a system that has no trust in me or my body, that sees birth as medical not emotional or spiritual, and that is so intent on following protocol that it can't see the woman behind the clipboard.
We had our first visit from Tara on Valentine's Day, and she brought red paper and silver string for my daughters to make heart decorations. And this summed up her visit. It was all about hearts. She wanted to get to the heart of my previous birth experiences, she wanted to understand the fears and hopes in my heart for this new baby and birth, she wanted to share the joy in the hearts of my whole family, and she wanted to connect with me, the birthing woman, at heart level. Instead of being left, as I was by the NHS, with worries and fears about my possible malfunctions, Tara stayed for six hours, and left us all with a feeling of great excitement about the months ahead and the wonderful birth experience we will all share.
I've exercised my freedom, I've raided my savings, and I've made my free choice - to have a midwife at my birth who I already know, who truly believes in the wonder of my body and who understands how to behave in order to make birth a beautiful and empowering experience for me and my family. But it's lucky I didn't wait any longer to get pregnant, because from September 2013, Independent Midwives are likely to be unable to practice as they currently do, due to an EU Directive that requires all health care practitioners to have indemnity. If nothing is done to save IM's, it seems likely that the free choice I just made to opt out of the NHS system for birth will no longer be one that is available to pregnant women in the UK.
I'll be writing more about Tara, Independent Midwifery and the campaign to save it, as my pregnancy progresses. In the meantime, please sign this petition to help their campaign:
Finding a workable and affordable solution for Independent Self Employed Midwives
We need to take action now to help preserve, improve and extend freedom of choice for all birthing women. Every woman should have the right to be attended by a midwife who is able to practice safely whilst remaining in touch with her heart. Every midwife should have the right to think, feel and work openly without her hands being tied by protocol and fear.
To find out more about Becky Reed, please visit the Facebook page: Justice for Midwife Becky Reed
To find your nearest Independent Midwife, please visit www.independentmidwives.org.uk
To find out more about our midwife Tara, please visit www.mindfulmidwifery.co.uk
Nearly forty years later, that baby - me - is pregnant for the third time, and wondering - am I free? Do I have full freedom of choice to have the birth I really want and need? Can I feel assured that anything that is 'done to me' in the name of medical science will be absolutely necessary and helpful? And are there restrictions that none of us are even able to see, and that will only become apparent when the baby inside me is fully grown and making their choices against a new and different backdrop?
Already I have met resistance to my plans to birth at home. At my first appointment with the midwife, the flag was automatically raised because my last baby was born weighing ten pounds four. This is me just after I birthed her. You can see just from my face what a life or death struggle it was:
She was born in the water after a second stage that lasted about ten minutes, without a whiff of gas and air, without a single vaginal exam, without any instructions on when or how to push, without a hand laid on me except in love, and without a stitch.
But because she was 'so big', 'they' want me to do things differently this time. They want me to have consultant led care, a hospital birth, and an induction at 38 weeks. (That's a whole month before either of my other babies have been born - I'm a ten month mama!)
The size of my baby might have been a 'flag' for them, but let me tell you, I have 'flags' too, and I know how to wave them. They might not trust my body - but I don't really trust them - there are things that make ME lose faith in THEIR abilities. I don't want to list in detail all of my reasons here - I never want this blog to single people out or publicly criticise individuals - but let's just say that a few incidents and some inside information has led me to feel a lack of confidence in my local maternity unit, and a strong suspicion that they don't trust birth and don't have much faith or understanding of it as a completely natural process.
This local feeling would seem to reflect a national and international picture. In her latest book, 'Birth and Sex', Sheila Kitzinger describes a climate in which 'choice' is a buzz-word that is meaningless when applied to women's actual realities: "The rhetoric of 'choice' ignores the pressure exerted on women to have a particular birth place - hospital - and kind of care - obstetric management, and the power of the medical system, so that discussions about choice often amount to emotional blackmail."
Worse still, it seems that even those midwives who wish to support real choices have their hands tied. Kitzinger writes, "Midwives who support women in their own free choices are more at risk of being reported to the Nursing and Midwifery Council and losing their registration."
The prosecution and persecution of midwives who refuse to, as Kitzinger puts it, "guide women to 'correct' choices", is epitomised currently by the case of Becky Reed, held in the highest regard by leading members of her profession, a member of the legendary Albany midwives, and up before the NMC on the 11th March. Her campaigners state, "For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy. If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices."
They might well have written, 'make it EVEN MORE difficult' for it seems like this is already very much the case. As a trainee midwife recently said to me, "I'm already learning that it's best to keep any strong views or opinions to myself, otherwise I'll risk not getting the job at the end of training.", and a qualified midwife confirmed, "At the end of the day, it's a job and you have to feed your family. If you make too many waves you put yourself at risk."
In this climate of fear and mistrust, how can any of us be truly free?
For me, too many flags and a search for true freedom have led me, as I did in my second pregnancy, to book an Independent Midwife. I just don't want to give birth in a system that has no trust in me or my body, that sees birth as medical not emotional or spiritual, and that is so intent on following protocol that it can't see the woman behind the clipboard.
We had our first visit from Tara on Valentine's Day, and she brought red paper and silver string for my daughters to make heart decorations. And this summed up her visit. It was all about hearts. She wanted to get to the heart of my previous birth experiences, she wanted to understand the fears and hopes in my heart for this new baby and birth, she wanted to share the joy in the hearts of my whole family, and she wanted to connect with me, the birthing woman, at heart level. Instead of being left, as I was by the NHS, with worries and fears about my possible malfunctions, Tara stayed for six hours, and left us all with a feeling of great excitement about the months ahead and the wonderful birth experience we will all share.
I've exercised my freedom, I've raided my savings, and I've made my free choice - to have a midwife at my birth who I already know, who truly believes in the wonder of my body and who understands how to behave in order to make birth a beautiful and empowering experience for me and my family. But it's lucky I didn't wait any longer to get pregnant, because from September 2013, Independent Midwives are likely to be unable to practice as they currently do, due to an EU Directive that requires all health care practitioners to have indemnity. If nothing is done to save IM's, it seems likely that the free choice I just made to opt out of the NHS system for birth will no longer be one that is available to pregnant women in the UK.
I'll be writing more about Tara, Independent Midwifery and the campaign to save it, as my pregnancy progresses. In the meantime, please sign this petition to help their campaign:
Finding a workable and affordable solution for Independent Self Employed Midwives
We need to take action now to help preserve, improve and extend freedom of choice for all birthing women. Every woman should have the right to be attended by a midwife who is able to practice safely whilst remaining in touch with her heart. Every midwife should have the right to think, feel and work openly without her hands being tied by protocol and fear.
~ o ~
To find out more about Becky Reed, please visit the Facebook page: Justice for Midwife Becky Reed
To find your nearest Independent Midwife, please visit www.independentmidwives.org.uk
To find out more about our midwife Tara, please visit www.mindfulmidwifery.co.uk
Great post.
ReplyDeleteI've just started a new blog hop, The Baby Shower, for all things pregnancy and new baby
and would absolutely love for you to link up. New posts and oldies very welcome.
Alice @ Mums Make Lists x
OK, I will try and have a look x
DeleteMilli this is SUCH a good blog post, I read it with sinking recognition when I came back from teaching a class yesterday. I had a group of excited expectant couples, yet while teaching them about choice I battled inwardly knowing that while my job is to be positive and build their confidence, and to teach that they have choices, I know what they will be faced with the minute they walk out of my door. It takes incredible strength of mind to listen to and to truly trust instinct and for doubt not to creep in based on that emotional blackmail you write about. I recently had a client who like you booked an IM because she could not enjoy her pregnancy based on her conflicting care and the stress created by it all. Even as a doula is was a struggle to keep her buoyant and positive. It felt like we were having to barricade ourselves in with trust, positivity and hope. This is her birth story, I thought it may be interesting for others. http://www.mindfulmamma.co.uk/kat-and-sid-and-maya/ Without the option of an IM I cannot even guess how this woman's birth would have evolved.
ReplyDeleteThanks, I will check out that story x
DeleteI am all for choice for women, and I do think independent midwifery should be saved. But, I think the issue is that saving independent midwifery will only 'preserve, improve and extend freedom of choice' for those women who can afford it. With fees of over £3,000 for an IM, it puts them firmly out of reach for a lot of women.
ReplyDeleteI do agree that the cost is an issue and of course what would be really REALLY great is for all women to be able to get this level of care on the NHS. However, with current medicalised attitudes so engrained, I think this is going to take a big shift and I'm at a loss as to how this might happen, despite wishing fervently that it would!
DeleteI also think that, whilst the fees for an IM are high, it is important to remember that they will lower them if you are in need, and also allow you to spread the cost. It is also worth saying that many people spend this much or more on a holiday, a television, or a wedding. However I am not negating those people who don't have that kind of money to spend on any of the above so please don't think I am in an ivory tower! I just know that for some, birth is not a priority, and they often regret this with hindsight. x
This is a brilliant post as always, and I loved reading it. I will share it widely! You look beautiful, in love, and so happy after your last birth....and how wonderful that you are pregnant again! So wonderful.
ReplyDeleteAs an NHS midwife I feel very sad and disappointed you were let down by the 'system', and I know you are not alone. We must try to help IMs get the insurance they need to make the choice available, and we need to improve maternity services for the majority of women.
Most midwives would love to have enough time to spend with women to do even half of what Tara did with you. But they are so pressured. And even if caseload midwifery became widespread, many midwives can't commit to practising this way due to family commitments. For a start, we need more midwives. There is much more to do!
Good luck...and keep posting...looking forward to reading about your progress, and your care.
Sheena x
Thank you Sheena! Yes, that day was absolutely FILLLED with love, I will never forget it!
ReplyDeleteI think you are right - there is so much more to do. For me, the short term solution is to work with an IM, but of course, as has been pointed out in another comment, this is not within everyones financial reach. I don't think the solution lies in integrating IM's into the NHS as a way of making them available to all - as within the current climate I feel we need professionals who have than independence from 'the system'.
I wish I knew the answer. I guess all I can do is keep writing - and hopefully by raising awareness of some of the issues some change might come. Luckily there are also some great campaign groups out there too and a lot of people passionate about birth and keen for change.
Love to you and thanks for your comment x
Perhaps you already know all this, but as support for the petition, it may be handy to have a „good practice” example from elsewhere, so I'm attaching the English version of the summary of how the system is organised in the Netherlands, where everything is the other way around in the birth and perinatal care department: http://www.knov.nl/docs/uploads/KNOV_Midwifery_in_the_Netherlands_20121112.pdf
ReplyDeleteI'm pretty sure the truth ought to be in the middle, in such a way as to allow everyone a true and uncostly CHOICE (while the UK system makes you pay if you want to opt out of a hospital, the Nl one makes you pay if you opt out of giving birth at home when you have no risk factor). But that battle is probably a later one. What I wanted to say is that on the site of the Dutch midwivery association I have found no alarm bells about this directive, which may mean that the issue is the way the internal (mental and political) organisation of a health system labels practitioners.